Nipple-sparing mastectomy? Implants and mammograms?

Question fromJanet:
Can you speak to "nipple-sparing" mastectomy, and also the mammogram considerations for gel silicone implants?

Answers -Jennifer Sabol, M.D., F.A.C.S.
There have been only very small, limited series of patients who have undergone a nipple-sparing mastectomy. In general, these are patients that would be considered low-risk for recurrence of the cancer within the tissue leading up to the nipple, meaning that their cancers are small, far from the nipple, and do not appear to have a large intraductal component to their cancers. Having said that, it appears that the risks of having a recurrence in this area are very small. Most surgeons will resect the actual projectile part of the nipple, leaving the color of the areola intact. Patients should be aware that even in the best of hands, there is a 10 percent chance of losing some of the skin in this area due to an inherent poor blood supply, and that the nipple created will not have normal sensation or erectile function. Finally, all nipple sparing mastectomies should be discussed further with the plastic surgeon involved with the mastectomy, as many patients have nipples that have begun to sag and may not be in the appropriate position when a reconstruction is ultimately performed. As for the mammogram considerations for the implants, in general, if a mastectomy is performed no further imaging with mammography should be performed on that breast. This is not because of risk to the implant, but because there is essentially almost no breast tissue left to screen.

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